Intro to Website by Counselor Cesar A. Cruz

Counseling Request Form

(Y)elder Development Program

Counseling Request Form

Person filling out form: □ Advisor □ Student □ Staff □ Parent Date:

Student’s Name: __________________________________________ Advisor:

Note: Counseling services are confidential. It would only be in extreme circumstances where other adults would need to be notified. Those circumstances will be discussed at each counseling session. This form will be kept private. Please fill out as much information as possible.

I would like to receive counseling services because (I would like to have this student receive counseling services because):

Please check all that apply. I have been (The student has been):

□ feeling depressed/sad □ feeling scared □ feeling angry □ feeling overwhelmed

□ having problems w/ family □ having problems w/ (my) partner

□ having personal problems: _________________________________________________________________________

□ having problems at school: _________________________________________________________________________

□ other:

I would like to receive information regarding (I would like this student to receive information regarding):

□ Sexually Transmitted Diseases □ pregnancy □ anger management

□ drug/alcohol abuse □ domestic violence □ developing positive study habits

□ other:

- - - - - - - - - - - - -

(For Staff Use Only)

□ I have reviewed this counseling request form and I approve that this student receive counseling services.

Staff (Advisor) Signature ____________________________________

- - - - - - - - - - - - - -

(For Youth Advocate/Counselor Only)

Counseling Session Appointment Date & Time: ________________________________

Student Notified: □ Appointment Met: □ Follow-Up Meeting: __________________________________________

Youth Advocate/Counselor Initials: ________________________________

HIV/AIDS Testing in Oakland

Education / Prevention

While the search for a vaccine to HIV intensifies, the best defense tools currently available to combat the virus is to educate individuals about high risk behaviors and to encourage them to adopt safer behaviors, so that we can together prevent new infections.

APEB's Education Prevention Department provides support groups for recovering substance users, transgendered individuals, gay and bisexual men and HIV positive persons. APEB provides prevention services that reach an additional 20,000 persons each year.

HIV TESTING SERVICES

APEB offers all individuals in Alameda County free and confidential HIV testing and counseling services. All testers are certified by the State of California. Our testing and counseling staff is committed to maintaining the highest standards of confidentiality and to serving you. All testing services are located at our offices near Jack London Square in Downtown Oakland.

APEB's Education & Prevention Staff is committed to provide the residents of Alameda County with sensitive and culturally effective services. For Free testing Services call (510) 663-7978.

Many Men Many Voices
This group is designed to help clients to grow mentally, physically, and spiritually.
Many Men Many Voices was developed to conduct prevention, education and intervention in communities of color where people struggle to survive with the HIV/AIDS virus and the many other co-factors associated with this rising pandemic. In response to the alarming rise of HIV/AIDS cases in Alameda County and the continued State of Emergency. Many Men Many Voices is exploring new ways to administer prevention health services.

Bongane Nyathi
Director of Education & Prevention
(510)663-7978
bnyathi@apeb.org

Jesus Moreno
Risk Reduction/HIV Testing Coordinator
(510) 457-4017
jmoreno@apeb.org

David Williams
Risk Reduction Specialist
(510) 663-7975
dwilliams@apeb.org

What to Do if Someone is Suicidal

24 Hour Crisis Line

Anywhere in Alameda County: 1-800-309-2131

Nationwide Hotline: 1-800-SUICIDE

WHAT TO DO

The suicidal person should have someone with him or her at all times.
Often after talking or seeking professional help, the individual may seem out of immediate danger of harming themselves. However, since suicidal thoughts often recur, the person needs sustained support for the next several days or weeks.
Take all suicidal talk seriously. If you have any doubts about someone harming themselves, take immediate action. The old cliché "better safe than sorry" is appropriate when assessing a possible suicide attempt. Encourage the person to talk about their feelings and thoughts. Listen to the feelings behind the words.
Evaluate the seriousness of the problem. Ask directly if the person is thinking of killing him or herself, if he or she has a plan, e.g., how it would be done and when. Asking does not cause a person to commit suicide. On the contrary, talking usually helps to relieve the burden of suicidal thoughts.
Take action to do something tangible: arrange a meeting with a therapist, a school counselor, a trusted family member.
Validate feelings and be supportive. With any suicide, there is ambivalence about taking one's own life. Often a suicidal person feels out of control and is relieved that someone else is making decisions.
Do not promise total confidentiality. You may need to involve others in the solution. Let the person know that everything will be done to prevent him or her from taking their life. Seek Professional Help.

If you don't know who to call, Crisis Support Services can refer you to an appropriate mental health resource.

Suicide Warning Signs

SUICIDE WARNING SIGNS
People who are depressed and suicidal nearly always give signals that they are in danger of harming themselves. Some of the warning signs of an individual who is at risk are:

· Change in Personality - Sad, withdrawn, irritable, anxious, tired, indecisive, apathetic

· Change in Behavior - Can't concentrate on school, work, routine tasks

· Change in Sleeping Patterns - Oversleeping or insomnia, sometimes with early awakening

· Change in Eating Habits - Loss of appetite and weight or overeating

· Loss of Interest - In friends, sex, hobbies, activities previously enjoyed

· Worry about Money or Illness - Either real or imagined

· Fear of Losing Control - Fear of going crazy, harming self or others

· Feeling helpless, worthless - "Nobody cares, everyone would be better off without me"

· Feelings of Overwhelming Guilt, Shame or Self-Hatred

· Feeling hopeless - "It will never get better, I will always feel this way"

· Drug or Alcohol Abuse

· Recent Loss - Death, divorce, loss of job, self-confidence, self-esteem

· Loss of Religious Faith

· Agitation, Hyperactivity, Restlessness

· Suicidal Impulses, Statements - Plans to harm self, giving away favorite things

More than one of these signs means that a person may be at particular risk and needs immediate attention. We have included more information on what to do for someone at risk. Adolescents, lesbian and gay youth and the elderly are particularly at risk for suicide.